Strict blood pressure control reduces the risk of adverse outcomes in chronic kidney disease but is difficult to achieve. To inform the design of an educational intervention for patients with chronic kidney disease and hypertension, we used focus groups to identify key patient issues, from both patient and healthcare professional perspectives. Framework methodology was used to analyse data and patient confusion emerged as the core concept. This was both an effect and, in some cases, a cause of the six key themes identified: lack of basic knowledge; conflicting advice; nature of diagnosis; changes in evidence-based practice; views on patient empowerment and views on the patient-health professional relationship. Educational needs identified involved addressing confusion by increasing both knowledge and motivation. In people with chronic kidney disease, confusion can lead to a lack of motivation and negative views that need to be addressed through appropriate education and support.
There are a number of challenges and debates surrounding the implementation of mental health interventions in schools. These include recognising the complexity of influencing factors and the interdependency of key components; the critical importance of monitoring school-based implementation in particular contexts; employing multimethod evaluation designs that can capture the complexity; and judging success using mental health and educational outcomes. These factors are shaped by both mental health and educational research. The prevention paradox focusing on the whole population ‘prevents’ more illness than targeting programs to specific individuals, and is exemplified in school mental health promotion that utilises an ecological or whole school approach. MindMatters, an innovative Australian mental health promotion and pr evention program, illustrates the challenges in this new field of endeavour. Its design and implementation are consistent with recommended effective practice, a comprehensive program that targets multiple health outcomes in the context of a coordinated whole school approach (Jané-Lopis, Barry, Hosman, & Patel, 2005). MindMatters moves beyond the sole focus on the curriculum to acknowledge the key roles of teacher professional development and whole school change within a strengths-based approach. As recommended by Jané-Lopis et al. (2005) measures of key school mental health outcomes are being used, ranging from absenteeism and drop-out rates to the development of social skills and academic achievement. The MindMatters evaluation suite of five separate yet interrelated evaluation studies illustrates some of the complexity involved.
Background: Post-transplant hypertension is a major modifiable risk factor for graft and patient survival. The aim of this study was to establish independent predictors for achieving systolic, diastolic and overall blood pressure target [Kidney Disease Outcome Quality Initiative (K/DOQI) target blood pressure <130/80 mm Hg] in renal-transplant recipients (RTRs) and to consider whether current management strategies are adequate to achieve this aim. Methods: The most recent office blood pressure readings were collected for 513 RTRs at least 6 months after transplantation. In addition, demographic data, comorbidities, medications prescribed, weight, duration of transplantation, and laboratory parameters were recorded. Logistic regression analysis was used to determine whether any covariables were significant (p < 0.05) independent predictors of controlled blood pressure (<130/80 mm Hg). Results: Approximately 50% of the RTRs had blood pressures <130/80. There was a marked terminal digit preference demonstrated. Subjects who were female, had diabetes, did not have heart disease or had a lower albumin:creatinine ratio had a higher probability to achieve good blood pressure control. Diabetics were more likely to be prescribed 3 or more antihypertensive agents. Conclusions: This study shows that improvements in blood pressure control can be achieved. People with diabetes were 2.1 times more likely to meet target blood pressure. Further improvements in blood pressure control may require different treatment strategies in addition to the current pharmacological approach.
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